If Forced to Take Risk, Most ACOs Would Leave Shared Savings Program

More than 70% of accountable care organizations (ACOs) likely would leave the Medicare Shared Savings Program (MSSP) if they were forced to assume risk, a new survey from the National Association of ACOs (NAACOS) found.

The web-based survey reached out to the 82 ACOs that started the MSSP in 2012 or 2013 and which will have to move to a two-sided ACO model beginning next year. Though only 43 percent of the ACOs responded, 71% said they would likely leave the program if they had to assume risk.

“These results paint a bleak future of what will happen if the government keeps its mandate to push ACOs into risk,” Clif Gaus, president and CEO of NAACOS, said in a press release announcing the results. “It’s naïve to think ACOs that aren’t ready will be forced into risk in what is ultimately a voluntary program. The more likely outcome will be that many ACOs quit the program, divest their care coordination resources, and return to payment models that emphasize volume over value.”


The MSSP has struggled to cut costs, with a study from consulting firm Avalere Health finding that the program actually boosted federal spending by $384 million between 2013 and 2016. Another study from the Kaiser Family Foundation determined that ACOs that accepted downside risk produced multi-million-dollar savings for the government, while the risk-free programs cost Medicare $72 million.

The survey specifically targeted to Track 1 ACOs, which are not required to accept any downside risk, but risk will become an issue as ACOs move through their second agreement periods, according to the NAACOS. Unacceptable levels of risk, concerns about unpredictable changes to the ACO model and CMS rules, and a desire for more reliable financial projections were cited as the top concerns by almost 40% of respondents.

The ACOs also indicated they would be “very” or “completely” likely to keep participating in Track 1 for a third agreement period if they were given the chance to continue in that track.


The NAACOS said MSSP ACOs that earned shared savings in 2016 had a significant drop in inpatient hospital expenditures and utilization, in addition to decreased spending on home health, skilled nursing facilities, and imaging.

“Additionally, ACOs participating over a longer period of time show greater improvement in financial performance,” the association said in the release.

Written by Maggie Flynn

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